title: The rate and mortality of postoperative venous thromboembolism of moderate risk surgery in Asian patients without thrombo-prophylaxis: systematic review with meta-analysis.
abstract: BACKGROUND
  The general gynecologic and neurologic surgeries are regard as carrying moderate risk for postoperative venous thromboembolism (VTE). This review analyzed the postoperative VTE rate of these surgeries in Asia.
  
  
  METHODS
  Inclusion criteria were: prospective study; deep vein thrombosis (DVT) diagnosed by venography, ultrasonography, or radionucleotide scan; and no thromboprophylaxis. The pooled proportion was back calculated from Freeman-Tukey variant transformation, using a random effect model.
  
  
  RESULTS
  Medline, EMBASE, Cochrane Library, and KoreaMed were searched. Fourteen studies (total population of 1,625) published from 1974 to 2008 were included. In general surgery, the pooled rate of all-sites proximal, isolated distal DVT was 13.4, 2.1, and 11.8 % (radionucleotide scan). The cancer patients carried a higher all-sites DVT rate (19.7 % radionucleotide scan and 17.4 % ultrasound). Gynecologic and neurologic surgery had 3.1 % (ultrasound) and 3.8 % (radionucleotide scan) all-sites DVT rate. For general, gynecologic, and neurologic patients, the pooled rates of symptomatic DVT were 1.5, 0.2, and 1.0 % respectively. The pooled rate of symptomatic pulmonary embolism (PE) was 0.4 % for general surgery. No patients died from PE (pooled rate 0.2 %); however, a single PE death was reported in the excluded study.
  
  
  CONCLUSIONS
  Postoperative symptomatic VTE was relatively low in Asia. Further study is required to stratify VTE risk and the need for thromboprophylaxis in individual patients.
authors.affiliation: Department of Surgery, Faculty of Medicine, Vajira Hospital, University of Bangkok Metropolitan, 681 Samsain Rd., Dusit, Bangkok, 10300, Thailand, burapa@vajira.ac.th.
authors.forename: Burapa
authors.initials: B
authors.lastname: Kanchanabat
authors.forename: Wikoon
authors.initials: W
authors.lastname: Stapanavatr
authors.forename: Sumonmal
authors.initials: S
authors.lastname: Manusirivithaya
authors.forename: Satid
authors.initials: S
authors.lastname: Srimantayamas
mesh_terms: D044466:Asian People; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000401:mortality*